Anticholinergics and Older Adults

August 10, 2020

By Robert Recker

Anticholinergics (Ant-I-Cul-In-Urge-Ics) are drugs used to stop involuntary muscle movements. These drugs treat various conditions and diseases, such as urinary incontinence, overactive bladder, and COPD (chronic obstructive pulmonary disease). They can improve the involuntary movements associated with Parkinson’s disease. While there are over 20 different anticholinergics, each is only available through a doctor’s prescriptions.

Anticholinergics to Treat Urinary Incontinence

Anticholinergics are used to smooth the urinary tract muscles, primarily the bladder, helping to improve urge incontinence and overactive bladder. In adults with urge incontinence, anticholinergics target the bladder and help reduce bladder spasms that cause urine leakage. Most commonly taken in a pill or tablet form, anticholinergics can be prescribed for extended-release (taken once daily) or immediate-release (consumed multiple times per day) depending on symptoms.

Anticholinergics improve incontinence symptoms for many adults; however, they have also shown to have potentially harmful side effects, particularly for older adults.

Negative Side Effects for Older Adults

Multiple research studies have demonstrated the dangerous side effects of anticholinergics for older adults. In fact, the American Geriatrics Society strongly recommends against the use of anticholinergics by older adults due to the risk of potentially dangerous side effects. In younger adults, the side effects may be uncomfortable, but the side effects become much more dangerous for the older population.

Side effects of anticholinergics include:

These side effects are particularly dangerous for older adults for several reasons:

1. Older adults are more likely to have comorbidities and other underlying health conditions. For example, some adults may have conditions that predispose them to glaucoma, or other eye problems, that anticholinergics can worsen, leading to increased risk of falls or other accidents. Similarly, in older adults, side effects like confusion, memory problems, or delirium are much more likely to be confused with the onset of Alzheimer’s or dementia, rather than a side effect of medication.

2. Older adults are more likely to be taking multiple medications, putting them at risk for additional side effects due to drug interactions. Approximately 30% of older Americans (aged 65+) take 8 or more prescription medications. Also known as polypharmacy, these drug interactions can heighten the adverse side effects of anticholinergics.

3. Finally, even the relatively mild side effects of anticholinergics can be damaging to at-risk adults. Side effects like dry mouth can reduce the ability to communicate. Increased heart rate can cause or worsen angina or chest pain caused by reduced blood flow. Drowsiness and sedation can lead to increased dependence and loss of muscle strength.

While not all older adults experience negative side effects from anticholinergics, older adults must be careful when adding additional medications to their daily. Caregivers and family members should understand possible side-effects of prescriptions and be aware these side-effects are often misinterpreted as signs of older age or other conditions.

It is important to talk with a doctor about if prescriptions, like anticholinergics, are right for you or someone your care for. Your doctors will know about the medication(s) you take and how that may impact your incontinence and incontinence treatment options.

Disclaimer: This blog provides general information about incontinence, health, and related subjects. The content in this blog, and any linked resources, are not intended and should not be taken as medical advice. If you or any other person has a medical concern, please consult a licensed physician.

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